OMB control number: 0720-0034
OMB expiration date: MM/DD/YYYY
DEPARTMENT
OF DEFENSE
2022 MILITARY HEALTH SYSTEM SURVEY ON PATIENT SAFETY
Thank you for participating in this survey! Your perspective on patient safety is important to the Military Health System (MHS).
Description of this Survey
The 2022 MHS Survey on Patient Safety (Culture Survey) is sponsored by the Department of Defense Patient Safety Program. Military and civilian staff with email access in MHS facilities are being asked to complete this survey. Survey questions ask for your opinions about patient safety issues, error, and event reporting in your MHS facility.
For more information on the background and purpose of this survey, please click here. [Clicking on link will open a pop-up box with the following content:]
Pop-up box content: |
What is the purpose of the survey? The purpose of this survey is to gather honest staff opinions regarding the culture of safety across our MHS facilities and to better understand you work experience. The survey will assist in raising awareness about patient safety matters and prioritizing efforts to provide safe care. |
What is the survey about? The survey asks for your opinions about areas deemed essential for maintaining a culture of patient safety, which includes: reporting errors, communicating feedback on an error, learning from errors, working with teams, handling care transitions, management support for patient safety, and staff work experience and well-being. |
How will information from this survey be used? Survey results will be used to identify areas where we shine as well as areas that may need improvement. The results will help prioritize activities promoting patient safety.
Why was I selected for the survey? All staff – military, civilian, and contractors – working in direct care facilities are invited to participate. |
Who
determined the questions?
I am retiring or I am new to this facility. Do you still want me to take this survey? Yes, your experiences and opinions are highly valued.
Why should I participate? Every individual working within an MTF provides a unique perspective on how we can deliver safe care to our patients. Your responses will help provide a comprehensive picture to help us continue delivering safe care to our patients. When will the survey results be ready? Results are expected in late 2022.
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How will the results be reported? Reports will be produced at various levels, for example, overall, by MTF, and work area. |
IF YOU HAVE QUESTIONS
For questions about this survey, click here for survey points of contact. [Clicking on link will open a pop-up box with the following content:]
Pop-up box content: DHA
IMO: Ms. Terry McDavid,
email: [email protected];
Ms. Heidi King, [email protected]
PRIVACY ADVISORY
Your responses are voluntary and your decision to participate or not will not affect your employment or any opportunity to receive future benefits. Your responses to this survey about your opinions about patient safety issues, medical errors, and event reporting will allow us to maintain or improve the quality of the patient care provided to all receiving treatment at your facility. If you do not wish to answer a question, or if a question does not apply to you, you may leave your answer blank. Your responses will be collected by an independent third party contractor and reported in aggregate form only; no individual responses will be reported. Results will be shared with Department of Defense and Defense Health Agency leaders. Authority: 10 U.S.C., Chapter 55, Public Law 102-484, E.O. 9397.
The public reporting burden for this collection of information, OMB Number 0720-0034, is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
For more information on the confidentiality associated with your survey responses, please click here. [Clicking on link will open a pop-up box with the following content:]
Pop-up box
content: Will
anyone be able to link my survey responses to me? This
is a confidential and anonymous survey.
Responses
will not be tracked to specific individuals nor will responses be
reported that may breach confidentiality. Only group statistics will
be prepared from the survey results, such as “70 percent of
staff rate patient safety in their work area as Excellent.” Will
my answers be reported to my commanding officer or be put in my
personnel file? Because
the survey is anonymous, none of your survey answers can be tracked
to you. Therefore, your survey answers will not be reported to your
commanding officer, nor will they be put in your personnel file. How
will demographic data be used in reporting survey results? Survey
results will only be reported in terms of group statistics, such as
“70 percent of staff rate patient safety in their work area as
Excellent.” Because the survey is anonymous, no one will match
your survey responses to you. If you do not wish to answer a
demographic question, you may leave it blank. What
authority do you have to ask me to provide you with demographic
data? This
is a voluntary survey. We have authority to conduct the survey
under 10 U.S.C., Chapter 55, Public Law 102- 484, E.O. 9397. The
survey has been approved by the Office of Management and Budget (OMB
Number 0720-0034,
Expiration Date TBD).
In
accordance with the Privacy Act of 1974 (Public Law 93-579), the
providing of personal information is completely voluntary. If you do
not wish to answer a question, or if a question does not apply to
you, you may leave your answer blank.
What country is your facility located in?
[Drop-down list of countries in alphabetical order where MTF/DENTACs are located.]
[Question is mandatory—survey respondents cannot proceed without answering this question. If respondent does not answer this question, please input the following message: “Please answer this question in order to move forward with the rest of the survey.”]
Please select the state where your facility is located.
[NOTE: This question should only appear for respondents in the United States. If a respondent selects any other country than the United States in Q1, the survey should skip to Q3.]
[Drop-down list of states and territories in alphabetical order.]
[Question is mandatory—survey respondents cannot proceed without answering this question. If respondent does not answer this question, please input the following message: “Please answer this question in order to move forward with the rest of the survey.”]
Please select your facility.
[Drop-down list of MTF/DENTAC facilities, in alphabetical order. Respondents should only see those facilities that correspond to their answers from Q1 and Q2.]
[Question is mandatory—survey respondents cannot proceed without answering this question. If respondent does not answer this question, please input the following message: “Please answer this question in order to move forward with the rest of the survey.”]
Based on the respective type of facility, skip to the appropriate question as designated below:
If MTF Hospital Go to question 4
If Not MTF Hospital, but is Ambulatory Clinic Go to “Medical Office” instrument
If Dental Clinic Go to “Medical Office” instrument
In what area of your Military Treatment Facility (MTF) do you work?
Hospital Go to question Ai, Hospital work area drop-drop down list
Ambulatory/outpatient clinic Go to question Ai, Clinic work area drop-down list
DENTAC or Dental Clinic Go to question Ai, DENTAC/Dental Clinic work area drop-
down list
[Question is mandatory for those who select an MTF hospital. If respondent does not answer this question, please input the following message: “Please answer this question in order to move forward with the rest of the survey.”]
SECTION A: Your Work Area
For the purposes of this survey, please consider the following definitions of key terms:
Your work area is the section, department, clinical unit, or area of the Military Health System (MHS) facility where you spend most of your work time or provide most of your clinical services.
An event is defined as any type of error, mistake, incident, accident, or deviation, regardless of whether or not it results in patient harm.
Patient safety is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of health care delivery.
What is your primary work area in your MHS facility?
[Drop-down list of work areas based on response to Q4.]
For more information on selecting your primary work area, please click here. [Clicking on link will open a pop-up box with the following content:]
Pop-up box
content: My
primary work area is not listed. How should I answer this question? You
should check "Other" and type in the name of your specific
work area in the text box. I
am not sure if someone in my work area or type of staff position
should answer the survey. Can you tell me? Every
individual who works in an MTF is invited to participate in the
survey. Individuals from different work areas within a Military
Treatment Facility provide unique perspectives and can help provide
a comprehensive picture of the culture of patient safety to help us
continue delivering safe care to our patients. If some questions do
not appear applicable, individuals may choose not to respond to
those. All
staff in MHS facilities with email access are being asked to
complete the survey. This includes Military Treatment Facilities and
Dental Treatment Facilities. It includes clinical and house staff
(interns, residents, fellows); non-clinical staff; active duty and
reservist military; GS and civilian contractors; volunteers; and
local nationals.
The
survey will not let me go further without answering which work area
I am from. Do I have to answer this question to complete the survey? Yes.
To provide information that can be used to improve patient safety in
particular work areas, we need to know which work area a particular
respondent works in. This information is not used to identify
individuals, and individual respondents will still remain anonymous.
Survey feedback will only be provided at the group level if 20 or
more responses are received from a particular work area.
[Please create separate drop-down lists of work areas depending on whether the respondent works in the hospital, an outpatient clinic, or a dental clinic (Respondents should only see the drop down list that corresponds to their answers in questions 2 and 3). In this way, only relevant work areas will be listed. Please use work areas listed in tab titled “Q Ai-Primary Work Area” of the “Patient Safety Survey Instrument Drop Downs” Excel spreadsheet.]
[Question is mandatory—survey respondents cannot proceed without answering this question. If
respondent does not answer this question, please input the following message: “Please answer this question in order to move forward with the rest of the survey.”]
[Before the following rating scale questions, please display this message: “From this point forward, if you do not wish to answer a question, or if a question does not apply to you, you may leave your answer blank.”]
How much do you agree or disagree with the following statements about your work area?
[All rating scale questions should contain a box for each category (6 boxes per question) in which an “x” appears when participants select it.]
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Strongly Disagree |
Disagree |
Neither Agree nor Disagree |
Agree |
Strongly Agree |
Does Not Apply or Don’t Know |
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Overall, how would you rate your work area on each of the following areas of health care quality?
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Poor |
Fair |
Good |
Very Good |
Excellent |
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SECTION B: Your Supervisor, Manager, or Clinical Leader
How much do you agree or disagree with the following statements about your immediate supervisor, manager, or clinical leader?
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Strongly Disagree |
Disagree |
Neither Agree nor Disagree |
Agree |
Strongly Agree |
Does Not Apply or Don’t Know |
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SECTION C: Communication
How often do the following things happen in your work area?
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Never |
Rarely |
Sometimes |
Most of the time |
Always |
Does Not Apply or Don’t Know |
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SECTION D: Reporting Patient Safety Events
Think about your work area:
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Never |
Rarely |
Sometimes |
Most of the time |
Always |
Does Not Apply or Don’t Know |
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In the past 12 months, how many patient safety events have you reported?
None
1 to 2
3 to 5
6 to 10
11 or more
SECTION E: Patient Safety Rating
How would you rate your work area on patient safety?
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1 Poor |
2 Fair |
3 Good |
4 Very Good |
5 Excellent |
SECTION F: Your Military Health System (MHS) Facility
How much do you agree or disagree with the following statements about your facility?
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Strongly Disagree |
Disagree |
Neither Agree nor Disagree |
Agree |
Strongly Agree |
Does Not Apply or Don’t Know |
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SECTION G: Workplace Stressors and Healthcare Worker Well-Being
Please respond to the following questions about your well-being and workplace stressors in your work/clinic area.
Using your own definition of “burnout,” please select one of the answers below:
a. I enjoy my work. I have no symptoms of burnout.
b. I am under stress, and don’t always have as much energy as I did, but I don’t feel burned out.
c. I am definitely burning out and have one or more symptoms of burnout, e.g., emotional exhaustion.
d. The symptoms of burnout that I am experiencing won’t go away. I think about work frustrations a lot.
e. I feel completely burned out. I am at the point where I may need to seek help.
What can be done to minimize “burnout”?
Please do not include any Personally Identifiable Information.
NOTE: Verbatim comments will be shared at the respective Headquarters level anonymously for improvement purposes.
Which number best describes the atmosphere in your primary work/clinic area?
a. 1 - Calm
b. 2
c. 3 - Busy, but manageable
d. 4
e. 5 - Hectic, chaotic
[IF 4 OR 5] What are the major causes of chaos in your work/clinic area?
Please do not include any Personally Identifiable Information.
NOTE: Verbatim comments will be shared at the respective Headquarters level anonymously for improvement purposes.
My control over my workload is:
b. Marginal
c. Satisfactory
d. Good
e. Optimal
Sufficiency of time for documentation is:
a. Poor
b. Marginal
c. Satisfactory
d. Good
e. Optimal
The amount of time I spend on the electronic health record (EHR) outside of normal work hours is:
a. Excessive
b. Moderately high
c. Satisfactory
d. Modest
e. Minimal/none
f. N/A
Please indicate your agreement or disagreement with the following statements about leadership.
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Strongly Disagree |
Disagree |
Neither Agree nor Disagree |
Agree |
Strongly Agree |
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SECTION H: Background Information
How long have you worked in this Military Health System (MHS) facility?
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How long have you worked in your current work/clinic area?
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Typically, how many hours per week do you work in this MHS facility?
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4. What is your staff position in this MHS facility?
Select ONE answer that best describes your staff position.
[Drop-down list of Staff Positions]
For questions related to being a local national, please click here. [Clicking on link will open a pop-up box with the following content:]
Pop-up box
content: I
am a local national and don’t see my staff type listed. How
should I answer? You
should check “Other” and specify your staff type in the
text box.
[Please create a drop down menu using list in tab titled, “Q H4 Staff Position” of “Patient Safety Survey Instrument Drop Downs” Excel spreadsheet.]
5. In your staff position, do you typically have direct interaction or contact with patients?
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6. How long have you worked in your current specialty or profession?
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Please select your staff type below:
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SECTION I: Your Comments
Please feel free to provide any comments about how things are done or could be done in your facility that might affect patient safety. Do not include any comments that identify individuals (patient, staff, providers, etc.) or events.
NOTE: Verbatim comments will be shared at the Headquarters level anonymously for improvement purposes.
Closing:
Thank you for completing this survey. This is the last question of the survey. Clicking the continue button below will submit your survey.
Completion Page:
Thank you for completing the survey.
Your response has been collected. You may now close your browser.
[Medical Office Survey: For survey respondents who selected an MTF designated as an Ambulatory Clinic or Dental Clinic in Q3]
SURVEY INSTRUCTIONS
Think about the way things are done in your clinic area (primary care clinic, internal medicine clinic, etc.) and provide your opinions on issues that affect the overall safety and quality of the care provided to patients in your clinic area.
In this survey, the term provider refers to physicians, physician assistants, pharmacists and nurse practitioners who diagnose, treat patients, and prescribe medications. The term staff refers to all others who work in the clinic area.
If a question does not apply to you or you don’t know the answer, please check “Does Not Apply or Don’t Know.”
If you work in more than one clinic area, when answering this survey answer only about the clinic area where you received this survey—do not answer about the entire facility.
If your clinic area is in a building with other clinic areas, answer only about the specific clinic area where you work—do not answer about any other clinic areas in the building.
What is your primary clinic area?
[Drop-down list of clinic areas.]
For more information on selecting your primary clinic area, please click here. [Clicking on link will open a pop-up box with the following content:]
Pop-up box
content: My
primary clinic area is not listed. How should I answer this
question? You
may not notice the exact name of your specific clinic area. Please
review the list of options available and choose the one that best
describes the area where you spend most of your workday. I
am not sure if someone in my clinic area or type of staff position
should answer the survey. Can you tell me? Every
individual who works in an MTF is invited to participate in the
survey. Individuals from different clinic areas within a Military
Treatment Facility provide unique perspectives and can help provide
a comprehensive picture of the culture of patient safety to help us
continue delivering safe care to our patients. If some questions do
not appear applicable, individuals may choose not to respond to
those. All
staff in MHS facilities with email access are being asked to
complete the survey. This includes Military Treatment Facilities
and Dental Treatment Facilities. It includes clinical and house
staff (interns, residents, fellows); non-clinical staff; active
duty and reservist military; GS and civilian contractors;
volunteers; and local nationals.
The
survey will not let me go further without answering which clinic
area I am from. Do I have to answer this question to complete the
survey? Yes.
To provide information that can be used to improve patient safety
in a particular clinic area, we need to know which clinic area a
particular respondent works in. This information is not used to
identify individuals and individual respondents will still remain
anonymous. Survey feedback will only be provided at the group level
if 20 or more responses are received from a particular clinic area.
[Question is mandatory—survey respondents cannot proceed without answering this question. If respondent does not answer this question, please input the following message: “Please answer this question in order to move forward with the rest of the survey.”]
[Before the following rating scale questions, please display this message: “From this point forward, if you do not wish to answer a question, or if a question does not apply to you, you may leave your answer blank.”]
SECTION J: List of Patient Safety and Quality Issues
The following items describe things that can happen in clinics that affect patient safety and quality of care. In your best estimate, how often did the following things happen in your clinic area OVER THE PAST 12 MONTHS?
[All rating scale questions should contain a box for each category in which an “x” appears when participants select it]
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Daily |
Weekly |
Monthly |
Several
times in the past 12 months |
Once
or twice in the past 12 months |
Not
in the past 12 months |
Does Not Apply or Don’t Know
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Access to Care |
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Patient Identification |
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Charts/Medical Records |
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Medical Equipment |
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SECTION J: List of Patient Safety and Quality Issues (continued)
How often did the following things happen in your clinic area OVER THE PAST 12 MONTHS? |
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Daily |
Weekly |
Monthly |
Several times in the past 12 months
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Once or twice in the past 12 months
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Not
in the past 12 months |
Does Not Apply or Don’t Know
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Medication |
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Diagnostics & Tests |
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SECTION K: Information Exchange With Other Settings
Over the past 12 months, how often has your clinic area had problems exchanging accurate, complete, and timely information with:
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Problems daily
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Problems weekly
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Problems monthly
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Problems several times in the past 12 months
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Problems once or twice in the past 12 months
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No problems in the past 12 months
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Does Not Apply or Don’t Know
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SECTION L: Working in Your Clinic Area
How much do you agree or disagree with the following statements? |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know
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SECTION M: Communication and Follow-up
How often do the following things happen in your clinic area? |
Never |
Rarely |
Some-
times |
Most
of the time |
Always |
Does Not Apply or Don’t Know
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SECTION N: Leadership Support
A. Are you in a leadership position with responsibility for making financial decisions for your clinic area? ![]() 1 Yes Skip to Section O 2 No Answer items 1-4 below |
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How much do you agree or disagree with the following statements about the leadership of your clinic area? |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know
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SECTION O: Your Clinic area
How much do you agree or disagree with the following statements? |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know
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SECTION P: Overall Ratings
1. Overall, how would you rate your clinic area on each of the following areas of health care quality?
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Poor
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Fair
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Good
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Very good
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Excellent
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a. Patient centered |
Is responsive to individual patient preferences, needs, and values |
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b. Effective |
Is based on scientific knowledge |
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c. Timely |
Minimizes waits and potentially harmful delays |
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d. Efficient |
Ensures cost-effective care (avoids waste, overuse, and misuse of services) |
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e. Equitable |
Provides the same quality of care to all individuals regardless of gender, race, ethnicity, socioeconomic status, language, etc. |
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2. Overall, how would you rate the systems and clinical processes your clinic area has in place to prevent, catch, and correct problems that have the potential to affect patients?
Poor
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Fair
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Good
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Very good
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Excellent
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SECTION S: Reporting Patient Safety Events
In the past 12 months, how many patient safety events have you reported?
None
1 to 2
3 to 5
6 to 10
11 or more
[All respondentsGo to Section G (Workplace Stressors and Healthcare Worker Well-being), H (Background Information), I (Your Comments) of main survey.]
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Ravi, Shreshta |
File Modified | 0000-00-00 |
File Created | 2022-03-01 |